Autonomic dysfunction / heart rythymn irregularities

[bmxtuffy]

Hi. I have recently been diagnosed with a 'mild' autonomic dysfunction & have over the last few weeks been experiencing some abnormal cardiac symptoms. I am very concerned about my heart & would really appreciate some feedback to my situation. I've chronicled my symptoms in the following bullet points-

* 40 year old overweight male with a 'mild' autonomic dysfunction
* Been on 10 mg of propanolol, twice daily for 4 months
* I noticed  a faint & lower than my usual pulse over three day period.
* During that period I experienced palpitations & flutters.
* At one stage I became incredibly fatigued after doing housework- heart rate of 42
* Went to the emergency department ECG & blood tests were normal.
* Decided to stop the morning dose of propanolol
* Heart rate went up a bit over the following few days, but was acting strange. It wasn't increasing much when walking & standing up. At one point when I was lying down it began to race to around 98bpm then slowed back down after 20 minutes.
* The following day I decided to rest in bed & not worry about it. Towards the end of the day, I got up & experienced several episodes of postural tachycardia. Upon standing I became dizzy & my heart went up from 75 - 148 BPM
* I went to the emergency department once again & the admitted me to hospital. I continued to experience the symptoms over the next few days.
* I was given another ECG, Stress echocardiogram & a 24 hour holster monitor. Nothing sinister was found.
* I was put on 5mg of Coralan which has seemed to control my tachycardia
* Since coming out of hospital my heart rate has been very low 55-60 BPM at rest.
* I decided to half the dose of Coralan to 2.5 mg (twice daily) & after two days there has been only a tiny increase in my heart rate.
* Last night at rest (after eating a bag of sweets) my heart began pounding. It went from 62 -80 BPM. It was beating so hard that I could feel it through clenched fists. This lasted for about 15 minutes.


I really wonder if I should get a second opinion as this has all been put down to being related to my autonomic dysfunction. Would 2.5 mg of coralan bring my heart rate so low? Can an autonomic dysfunction cause a slow resting heat rate? Could I be suffering from arrhythmia?
As I mentioned before, any advice would be extremely welcome as this is causing me a great deal of distress.

All the best

Rob

[SarcoidMTHFR]

You may be interested in this article...

Cardiac Autonomic Dysfunction
Effects From Particulate Air Pollution and Protection by Dietary Methyl Nutrients and Metabolic Polymorphisms
http://circ.ahajournals.org/content/117/14/1802.full

It seems to link the MTHFR methylation errors to Autonomic Dysfunction.  MTHFR errors apparently prevent you from utilizing the cheap synthetic vitamins...folic acid and cyano-cobalamin (B12) effectively.  You basically end up with a cellular deficiency even though your serum levels look fine.  If you find the correct Dr to help you, they will probably check to make sure your other levels aren't off, and then recommend that you use natural or bio-available Folate (NOT folic acid) and B12 in the methylated forms to counteract your low MTHFR enzyme level.

I ran my DNA and a methylation profile using 23and me.com and Genetic Genie....and found that I carry multiple MTHFR mutations/metabolic polymorphisms.

I think its certainly something worth discussing with our physicians!

[jc4385]

Do you mind if I ask how you were diagnosed with autonomic dysfunction?  The reason I ask is because I'm wondering how much of a workup you have had since that will help your doctors guide treatment.  I haven't heard of BB being prescribed as a sole treatment for dysautonomia, so any extra info you have might help.

I have both POTS and cardiac problems which we are trying to get to the bottom of.  My understanding is that they two are separate workups and I must close the loop on both.  

BBs are known for their ability to slow pulse and cause heart rhythm abnormalities.  I'm not a doctor, but inclined to think most of those side effects you are complaining about above are related to the BB.  BBs can also cause some changes in BP which can lead to lightheadedness, fatigue, and syncope.  You don't say what your BP was in all this, so I'm wondering if it may have gotten too low - these sound like the same effects which are why they won't let me go on a BB despite everything else indicating I should - my BP of 100/70 contraindicates for even a pediatric dose.

If you haven't been diagnosed or treated by a Neuro familiar with dysutonomia, I would try going there.  Definitely keep your cardiologist given the number of risk factors you have and the fact it sounds like you still need ongoing workup, but neurology approaches dysautonomia differently.  You may be like me and have two separate things going on.

Things will get better, I'm hoping it all comes together for you soon.